EDI Solutions

More than 25% of all healthcare claims are denied when initially presented for payment and returned unpaid. The result is a chokehold on your revenue and your organization’s fiscal well being. InstantFile has partnered with Encite to provide the most comprehensive transaction services system (EDI) on the market today. Our Transaction Services improves efficiency and controls costs through the use of leading edge data analysis technologies. You will increase the rate of submitted claim payments, lower receivables, and reduce overhead.

Clearinghouse Services

Automated Electronic Claim Services
Efficient claim forwarding and routing is a critical step in the healthcare revenue cycle. We provide connection to most commercial and government payers to ensure fast and comprehensive EDI submission and retrieval of claims, electronic EOBs and Remittance Advices. Our Clearinghouse Services are integrated and available to users of the Claim Editor to permit quick, convenient submission of "clean" claims.

Clearing House Services Gives You

Secure, one-click submission when using claim editing clients over an internet connection
Connection to most commercial and government payers when using the "All-payer solution
Automatic data formatting for every supported payer
A cost-effective, bundled pricing alternative to other clearinghouse services

Claim Editor

The Next Generation in Claim Editing & Scrubbing
Say goodbye to submitting claims that are repeatedly denied over many months...even when all published claim-filing rules have been followed!

Our user-friendly, automated process solves the problem of first pass denials by capturing and cataloging the unpublished edits payer actual use in claims adjudication. Our state of the art Claim Editor uses this payer information and its proprietary predictive technology to pinpoint every error in every claim before initial submission. The advantages are extraordinary. Imagine the benefit to your organization when claims are submitted quickly and easily submitted electronically and approved on initial presentation.

To date tens of millions of claims have been successfully scrubbed and submitted. Shouldn’t you be using this effective tool, too?

Transaction Services’ Claim Editor eliminates denial of eligible claims with features that include:

Millions of commercial and government payer edits almost half unpublished
Automatic updates every week
Field-proven technology
Automated electronic claims submission

Transaction Services give you the benefits of

Accelerated cash flow
Receivables reduction of up to 20%
An AR days reduction of up to 20%
Lower claims processing cost
Improved organization work processes through denial analysis
Supported Edits:
- All seven recommended WEDI/SNIP levels.
- Procedure coding to check age and gender restrictions as well as CCI policy compliance.
- Medical Necessity using CPT/ICD9 crosswalk data and the ordering of procedures for maximum reimbursement.
- Diagnosis coding using valid primary diagnoses, proper levels of specificity and the inclusion and ordering of any required accompanying diagnoses.
- Situational/conditional fields and services/procedure related fields are checked to see if they are required and reported.
- Logical date-field relationships (e.g., date of onset on or before date of service).
- Payer-specific published rules editing (Medicare, Medicaid, commercial carriers, etc.).
- Unpublished payer-specific rules editing.

Eligibility Verification

Issues with Patient Eligibility

The eligibility of at least half of all patients seen is unknown until receipt of an EOB week after the date of service.
One in four of all claims initially submitted is rejected and on average, 1 in 17 is ultimately denied due to ineligibility.
Less than 50% of patient-pay receivables that result from ineligibility are collected.
Eligibility verifications in most offices are limited to only those that the staff has time to complete via 1-800 phone calls.

Our Transaction Services solve this problem by delivering critical eligibility data to your desktop in a matter of seconds using a standard web browser. This allows you to collect appropriate funds from both patient and payer or make alternative financial arrangements before service is rendered.

Eligibility Features

Real-time, all-payer access via a single secure website
User-friendly eligibility responses in plain English
Direct eligibility responses per payer website
Single patient or batch eligibility requests; stand alone or POMIS integration

Eligibility helps eliminate

"On Hold" waits for verification
The need to access multiple website

EDI Solutions

Clearinghouse Services

Claim Editor

Eligibility Verification

Interested in learning more?

Corporate Headquarters

For more information visit: